Original Article

Role of platelet-rich plasma in chronic alopecia areata:

Our centre experience

Sukhbir Singh
Department of Burns, Plastic and Aesthetic Surgery, Kamal Hospital, Kaushambi, Uttar Pradesh, India

Address for correspondence: Dr. Sukhbir Singh, S-212, Greater Kailash Part 2, New Delhi - 110 048, India. E-mail: [email protected]

ABSTRACT
Aim: The aim of the study was to evaluate the efficacy of platelet-rich plasma (PRP) in the
treatment of chronic alopecia areata (AA). Material and Methods: This is a prospective study that
was conducted at Kamal Hospital, Kaushambi in which 20 patients who attended the outpatient
department were enrolled for the study. All the patients had h/o patches and taken various line of
treatments for a duration of 2 years. All the patients were biopsy-proven positive for AA disease.
There was no randomisation done since all of them were healthy young adults. The patients’age
ranged from 25 to 35 years, and none of them had any co-morbidities. Results: Of 20 patients,
only one patient had a relapse. None of the patients had any side effects, and all of them tolerated
the procedure well. Conclusion: We wish to conclude that PRP has a definite role in treating AA
infections. However, still more long-term follow-up, studies are required for further validation of
results and labelling it as a 100% cure for people suffering from AA with recurrences which are so
common.

KEY WORDS
Alopecia areata; platelet rich plasma; cicatricial alopecia

INTRODUCTION Platelet-rich plasma (PRP) is a preparation of autologous

platelets in concentrated plasma. It has been investigated

A
lopecia areata (AA) is a common, non-scarring, in several disciplines of medicine for its role in wound
autoimmune disease that can affect any hair- healing. In our centre, we have treated 20 patients of
bearing area. Though various lines of management alopecia areata with PRP alone, without any side effects,
have been described for this condition ,[1-5] all have
and with good preliminary results as seen in Figure 1a
significant relapse rate with, with side effects of the
and b.
medications too. In this paper, we discuss 20 patients
of chronic, biopsy proved AA disease, who had taken
(unsuccessfully) 2 years of various forms of therapy. We decided to use PRP for improvement of the patient’s
outcome as we had success in the use of PRP for hair
rejuvenation and cicatricial alopecia.[6,7] There has been
Access this article online
only one double-blinded, placebo and active-controlled,
Quick Response Code:
Website: half-head, parallel group study on 45 patients to evaluate
www.ijps.org
the efficacy and safety of PRP in AA patients.[8] This study
concluded that PRP is a safe and alternative treatment for
DOI:
10.4103/0970-0358.155271
AA, but further controlled trials are needed to validate
the findings.
57 Indian Journal of Plastic Surgery January-April 2015 Vol 48 Issue 1
 Singh, et al.: Role of platelet rich plasma in chronic alopecia areata: Our centre experience

a b

a b
Figure 1: (a) Pre-intervention state of the patient with alopecia areata
(b) post-platelet rich plasma status-note the improved sustained hair growth
at the end of 1 year

c
MATERIAL AND METHODS Figure 2: (a) Pre-intervention state of the patient with alopecia areata (b) post-
platelet rich plasma (PRP) status-note the improved hair growth at the end of
6 months (c) post-PRP status-note the relapse at the end of 1 year
This is a prospective study that was conducted at Kamal
Hospital, Kaushambi in which 20 patients who attended DISCUSSION
the outpatient department were enrolled for the study.
All the patients had h/o patches and taken various lines
Proper counselling of the patient is very important before
of treatments for a duration of 2 years. All the patients
starting treatment for this disease since it is associated
were biopsy-proven positive for AA disease . There was
with recurrences very commonly. All the treatments
no particular randomisation done since all of them were
available as of today are associated with both relapses
healthy young adults. The patients’ ages ranged from
and side effects, which affects the psychosocial life of the
25 to 35 years, and none had any co-morbidities. All the
patients were explained about the procedure in detail. A patients in the long run.
consent form was signed by each patient. All the patients
were followed up at 4 weekly intervals for a duration of Various treatments are available for AA affliction. The effect
6 months and then at the end of 1 year. All the patients of a single intralesional corticosteroid injection has been
received 6 sessions of PRP. Ethics committee approval was observed to persist for up to 9 months. In a few studies,[2]
taken prior to the commencement of the study. reported relapse rates were 29% in limited AA and 72% in
alopecia totalis during a 3-month follow-up period.[1] The
Treatment protocol reported relapse rate of topical steroids is 37-63%.[4,5] In
A volume of 25 ml blood was taken from each patient and a placebo-controlled, double-blind study, hair regrowth
the PRP solution obtained from the lab was used within was observed in 63.6% and 35.7% of the minoxidil-treated
30 min of its preparation. It was injected in the scalp after and placebo groups, respectively.[9] In another study, hair
local anaesthesia application, in the subfollicular plane. regrowth was achieved in 38% and 81% of patients treated
Patients were sent home once the PRP session was over, with 1% and 5% topical minoxidil, respectively.[10] Side
and they were in a stable condition which was confirmed
effects include contact dermatitis and facial hypertrichosis.
after checking all the vitals. They were called for review
Various forms of systemic corticosteroids have been used
after 4 weeks for the next session and told to report earlier
in different regimens. In one study, a once-monthly oral
if any need arose . All the patients received 6 sessions of
pulse of 300 mg prednisone induced a complete response
PRP at 4 weekly intervals. Patients were reviewed every
month for 6 months and then at the end of 1 year. in 41% of patients.[11] A similar effect has been reported
in a placebo-controlled trial of oral prednisolone 200
RESULTS mg once weekly in the treatment of extensive AA.[12] The
relapse rate was 25%, and side effects of the therapy were
Of the 20 patients, one patient had a relapse, and his hair noted in 55% of patients.[12] Other medications include
regrowth was also minimum [Figure 2a-c]. None of the methotrexate (with relapse rate of more than 50%);
patients had any side effects, and all of them tolerated cyclosporine (with a high relapse rate of almost 100%);[13]
the procedure well. azathioprine, and others.
Indian Journal of Plastic Surgery January-April 2015 Vol 48 Issue 1 58
 Singh, et al.: Role of platelet rich plasma in chronic alopecia areata: Our centre experience

There has been only one double-blinded, placebo and 5. Pascher F, Kurtin S, Andrade R. Assay of 0.2 percent fluocinolone
acetonide cream for alopecia areata and totalis. Efficacy and
active-controlled, half-head, parallel group study on side effects including histologic study of the ensuing localized
45 patients to evaluate the efficacy and safety of PRP in acneform response. Dermatologica 1970;141:193-202.
AA patients,[8] which concluded that PRP is a safe and 6. Singh S. Platelet rich plasma — Protocol for its preparation and
its role in hair rejuvenation. Aestheticians J 2013;3:40-2.
alternative treatment for AA, but further controlled
7. Singh S. Role of platelet rich plasma in primary cicatricial
trials are needed to validate the findings. Our study alopecia. Aestheticians J 2014;4:42-4.
showed relapse in just one case and no side effects 8. Trink A, Sorbellini E, Bezzola P, Rodella L, Rezzani R, Ramot Y,
in any of the 20 treated patients. Though we have et al. A randomized, double-blind, placebo-and active-controlled,
half-head study to evaluate the effects of platelet-rich plasma on
achieved initial success with PRP, further follow-up is alopecia areata. Br J Dermatol 2013;169:690-4.
required, and more studies needed to validate the final 9. Price VH. Double-blind, placebo-controlled evaluation of topical
results. minoxidil in extensive alopecia areata. J Am Acad Dermatol
1987;16:730-6.
10. Fiedler-Weiss VC. Topical minoxidil solution (1% and 5%) in the
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How to cite this article: Singh S. Role of platelet-rich plasma in
Int J Dermatol 2003;42:572-5.
chronic alopecia areata: Our centre experience. Indian J Plast Surg
4. Tosti A, Piraccini BM, Pazzaglia M, Vincenzi C. Clobetasol
2015;48:57-9.
propionate 0.05% under occlusion in the treatment of alopecia
totalis/universalis. J Am Acad Dermatol 2003;49:96-8. Source of Support: Nil, Conflict of Interest: None declared.

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